Non-invasive determination of pressure recovery by cardiac MRI and echocardiography in patients with severe aortic stenosis: short and long-term outcome prediction

Figures

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  Figure 1.. Schematic drawing of the course of the blood stream during left ventricular (LV) systolic ejection from the LV outflow tract to the tubular ascending aorta.

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  Figure 2.. Representative transthoracic echocardiography (TTE) image (parasternal long axis view, end-diastolic) showing the ascending aorta and diameter measurement at the level of the sinotubular junction (STJ).

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  Figure 3.. (a) Schematic drawing and (b) representative steady-state free precession (SSFP)-cine cardiac magnetic resonance image (3 chamber view) of the ascending aorta showing diameter measurement positions: 1, aortic annulus; 2, Sinus of Valsalva (SoV); 3, sinutubular junction (STJ); and 4, proximal tubular ascending aorta.

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  Figure 4.. Scatter plots showing correlation between cardiac magnetic resonance imaging (MRI) and transthoracic echocardiography (TTE) results for (a) pressure recovery (PR), r = 0.73 (P <0.001); and (b) index pressure recovery (iPR), r = 0.69 (P <0.001), measured at the sinutubular junction.

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  Figure 5.. Frequency of clinically relevant pressure recovery (dark grey) and aortic stenosis severity reclassification (light grey) depending on imaging modality (transthoracic echocardiography [TTE] versus steady-state free precession [SSFP]-cardiac magnetic resonance imaging [CMR] in 3-chamber view [3CV]) and measurement location for CMR (sinus, Sinus of Valsalva; stj, sinutubular junction; or pAoA, proximal tubular ascending aorta); TTE measurements were obtained at the end of diastole, and SSFP measurements at the beginning of systole. Plx, parasternal long axis.

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  Figure 6.. Changes of aortic stenosis severity from transthoracic echocardiography (TTE) measurements and cardiac magnetic resonance imaging (MR) in 3-chamber view (3CV) measurements without consideration versus with consideration of pressure recovery (PR). EOAi, effective orifice area index; PLX, parasternal long axis; ED, end of diastole; ELI, energy loss index; STJ, sinutubular junction; BS, beginning of systole.